Reaching and engaging Hispanic women, given their central role in families, is a critical strategy in efforts to reduce disparities and improve health outcomes for adults and children in these communities. Quality prenatal care is designed to promote health and reduce risks for women, infants, and families before, during, and after pregnancy. Unfortunately, Hispanic women are twice as likely to receive late or no prenatal care as non-Hispanic white women. Currently at 11 million, over the next several decades the number of Hispanic women in their childbearing years is projected to increase exponentially. The long-term goal of the proposed project is to improve access to quality, linguistically and culturally appropriate prenatal education and care for Hispanic women. The program will be based on the Teach-With- Stories (TWS) Method" developed for empowerment-based group education. The existing De Madre a Madre/From Mother to Mother prenatal care photonovels will be redesigned according to the prototype developed in Phase I to be distributed via the Teach-With-Stories Free Publication Network. Phase II aims will focus on the development of program components that address implementation factors identified in Phase I to facilitate the adoption, integration, and sustainability of a Teach-With-Stories lay health educator model. The program will be designed to build community capacity to offer and evaluate prenatal education in community-based or clinic-based sites The goal is to increase access for Hispanic women and foster opportunities for partnership with systems of care. In addition, the research team will develop and test study instruments and data collection protocols for a subsequent formal control design study. The study team will achieve these aims through a collaborative, participatory-based development process coupled with a Plan-Do-Study-Act (PDSA) continuous quality improvement methodology. This will ensure that the products are medically accurate, culturally sensitive, and effective in practice. Hispanic consumers will field-test the photonovels for readability and cultural and linguistic appropriateness. In addition, the complete program will be tested to determine its effectiveness as compared to a control-match group of Hispanic women who receive usual care. PUBLIC HEALTH RELEVANCE: Positive, culturally sensitive experiences in prenatal care can have a long-term impact on the use of healthcare services by Hispanic women and their families. An empowerment-based lay educator model designed to address system and provider needs unique to prenatal care could help generate cost-savings to the health care system, improve quality of care, and address the multiple needs of this growing population. A commercially successful model for prenatal education could be adapted for other health topics and potentially for other traditionally underserved populations.